After the World Health Organization (WHO) classified the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly known as COVID-19, as a global pandemic on March 11, 2024, the American Medical Association (AMA) worked fast to quickly approve and release Current Procedural Terminology (CPT) codes. The CPT codes help expedite the planning phase by creating a more efficient data-collection process to support resource allocation and budget administration. In addition, the rapid increase in the number of COVID-19 cases in America and abroad further emphasized the importance of CPT codes.
With the current progress in the COVID-19 pandemic, it is easy to be overwhelmed. Therefore, it is important to keep yourself informed as much as possible, only reading information from reliable resources like Alpha II.
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Ama Has Approved A New Code To Be Added To The Cpt Code Set
The AMA or the American Medical Association has recently announced that the Editorial Panel for the CPT has approved another code that is to be added to the Current Procedural Terminology code set. This new addition will help to streamline the data-driven resource and will also enable allocation planning in the combat against the COVID-19 virus as the number of cases is on the rise.
The code has been put into effect immediately. It is being used as the industry standard for the reporting of the tests for the COVID-19 virus across the country’s healthcare system. Also, CPT code 87535 is equipped with medium and short descriptors and the same can be accessed via the AMA website.
What is CPT 87635?
CPT 87635 is the code released by the CPT Editorial Panel on March 13, 2024, to meet the needs of the ongoing battle against the COVID-19 pandemic. The long descriptor of the CPT 87635 code is Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.
In this code, the nucleic acid amplification test detects the presence of the unique genetic material of COVID-19 in respiratory samples from patients. If the test finds traces of the virus’s ribonucleic acid, this suggests that the patient may have COVID-19. Most doctors and medical coders would recognize existing codes already part of the pathology and laboratory section of the CPT code set. However, these codes are applied for nucleic acid assays that detect a wide range of respiratory viruses in a multiplex polymerase chain reaction. Therefore, CPT 87635 is a specific code only used to detect COVID-19 and any pan-coronavirus type.
The Center for Disease Control and Prevention (CDC) updated its guidelines for specimen collection. It recommends taking swab samples from multiple pharyngeal sites, with each patient being tested numerous times in a day.
As an overall suggestion to be safe, physicians, health care workers, and health care providers should make it a point to check with local and national payers regarding the specific reporting guidelines for CPT codes.
The AMA assembled the CPT Panel as an independent body to act as the only authority to create, release, and edit the CPT code set. AMA and the CPT also collaborate closely with their peers from the CDC and other relevant experts from the medical and health care provider fields to ensure that all CPT codes developed and released deliver accurate diagnostic reports and meet the immediate needs of the providers.
The CDC and AMA work together to provide updates and produce guides to keep up with the fast-changing pace of the COVID-19 pandemic and the needs of the people. Alpha II has resources on its website to help you remain informed and empowered in all your medical decisions.
AMA Has Introduced New Updated Guidelines
AMA has convened an independent body called the CPT Editorial Panel whose sole authority is to manage various revisions to the code set of CPT, an expedition of the code development procedure for the various COVID-19 tests. The approval, review, and development of the new CPT code involved a lot of input from the CDC, the practicing physicians, and other relevant experts working in the same field.
The AMA has invested numerous resources to keep the physicians up to date with the CDC’s latest guidelines and further updates, which includes the launch of Physician Guide Of AMA For COVID-19. This pdf will act as a quick start reference for the physicians and will help them adapt their practices to meet the pandemic’s requirement. This book is a sharable, downloadable, and expanded version of the resources available to the physicians.
According to AMA the CPT code 87635 is one of the most appropriate tests for testing the presence of the novel coronavirus. The other codes, especially the CPT codes 86328 and 86769 should be used only for serologic lab testing of the coronavirus.
The providers are needed to manually upload all three code descriptions on their EHR systems. This should be done as per the standard process of early release for the CPT codes. These codes must be included in the complete code set of CPT in the data file for 2024. This file will be available in November of this year.
How are the HCPCS codes superior?
CMS has also introduced new HCPCS codes that are to be used for other coronavirus-related tests. However, the laboratories and medicare reimbursement providers tend to double the rates for the HCPCS codes, namely, U0004 and U0003. These codes have high reimbursement rates because they make use of high-quality technology.
With the help of these technologies, the laboratories can easily process more than two hundred tests in a day. However, CMS in their updated guidance list stated that although they have high reimbursement rates, one should not use them to bill for the tests that are needed to detect the presence of coronavirus antibodies.
The CMS experts expect these codes to have a quicker response to coronavirus outbreaks, mainly in hospitals and nursing homes.